Tag Archives: health care

If you’re a limited-government advocate, you’re almost guaranteed to be a detractor of the Affordable Care Act (ACA) colloquially known as Obamacare. The AHCA from the GOP designed to replace the ACA, has recently been passed by the House, but is largely believed to not have a chance in the Senate.

President Barack Obama delivers a health care address to a joint session of Congress at the United States Capitol in Washington, D.C., Sept. 9, 2009. (Official White House Photo by Lawrence Jackson)

If you’re old enough to recall the Clinton presidency, you may remember that Hillary Clinton was appointed by her husband Bill to the “Task Force on National Health Care Reform.” Her mission was to improve the state of health care in the United States, and her suggestion was a single-payer system similar to what many nations in Europe and Canada use.

This single-payer system was originally supported by President Obama as well, prior to becoming president. But the political climate in America is still one of limited government more often than not, so the ACA was a compromise Obama was willing to make to achieve his goal of every American having “basic access to health care.”

The bill being one of the larger in American history had a lot to it, and as such, had a lot of things people from many places on the political spectrum took issue with.

Many libertarians like myself, are left wondering why government should be involved in health care in the first place. I think our position is pretty consistent and straight forward, although I always cringe at the idea of speaking for other people. But I will try to state the libertarian position as I’ve consistently observed it.

Health Care is not a Right

The argument from those pushing for government-funded health care is the idea that it’s a right—some going so far as to say it’s an extension of your right to life. But let’s break that down for a second, as it depends on how you define rights in general.

The Constitution doesn’t mention health care, so there’s no honest metric one could use to say it’s a Constitutional right. However, most argue that it’s a basic human right.

The United States Constitution

If we compare health care to other well-understood basic human rights, it becomes fairly easy to understand how healthcare is different. Religious freedom, freedom of speech, freedom in general, life, air, etc., these things all have one thing in common. They do not require any action from another person.

Rights by definition, should not involve the action of another person, because otherwise, your right to have their labor or goods trumps their right to keep their labor or goods—therefore one person ends up having more rights than another.

Healthcare requires goods produced by the pharmaceutical industry and medical equipment from manufacturing companies, as well as the efforts of a medical practitioner like a doctor or nurse, it isn’t just something that exists in the ether for all to consume.

If we force those people to do such work through laws like EMTALA, which require emergency rooms to treat people, regardless of their ability to pay, this arguably violates the 13th amendment which states:

“Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.”

Making a doctor save someone’s life versus giving them the option, even if they get paid to do so, is both immoral and potentially unconstitutional.

A quick internet search yielded no instance where SCOTUS has granted certiorari (agreed to hear) any petition challenging EMTALA, although the 11th Circuit upheld the law in BAKER COUNTY MEDICAL SERVICES INC v. ATTORNEY GENERAL, August 2014, The challenge there was not against the 13th amendment, it was against the 5th, which reads as follows. (The bold portion was what the challenge argued against.)

No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation.

The reason the law was upheld, is because the law only applies to hospitals which voluntarily work with Medicare. So the court ruled that their participation was voluntary, while the plaintiffs argued not taking Medicare is an undue financial burden, and therefore not really a choice. (Almost all hospitals accept medicare, because they’d have a hard time making a profit if they rejected all those who are on it). Government often gets so involved, that they create the problem by virtue of their intrusiveness in the marketplace.

The Supreme Court Of The United States

Moving past EMTALA, if we assume that the doctors help someone voluntarily, and expect to get paid by government, then the second issue arises that the taxpayer and/or fellow healthcare consumers, end up footing the bill.

What logical argument can one make to indicate that person A is responsible for person B? While it’s certainly altruistic in its intent, and I understand the idea that if we all band together to help those in need, society is potentially better off because of it; that’s still a moral judgement you’re making that others may not share with you.

There’s also a rather large hypocrisy in play for these beliefs. Speaking to a doctor who promotes a single-payer system, my argument was that at some point, that doctor expects to retire. While my taxes help pay for health care, my dollars don’t cure anyone. My dollars pay a doctor who then cures someone.

So if a doctor chooses to take a day off, or retire, they have opted to not help someone who could have used help. If I were to tell those doctors that now the government gets to dictate how many hours they work, and what time they may take off, they’d be apoplectic. Yet I do not get to choose how much of my paycheck funds the health care of another.

Much like mass and energy are interchangeable because one can be transformed into the other, so are labor and money for the same reason. Forcing someone to give up their money to pay for services they’re not receiving is no more moral than forcing them into servitude for the same purpose.

As much as it may seem heartless not to do it, you cannot divorce that fact from the equation.

This brings me to the “are you just going to let them die” argument, that is often bandied about as justification for forced medical care.

The number of visits to a doctor that are life threatening vs just quality of life issues are very small. Even Emergency Room visits, according to one government study puts the number of visits that could have been treated by a normal doctor or Urgent Care facility vs the emergency room at somewhere between 13.7 and 27.1%. That doesn’t include all the times people just went to their doctor, or an Urgent Care facility. So it is more than fair to assume that less that 10%, maybe even less than 1% of all medical care required is non-life-threatening.

If that’s true, then most of the time care may be refused, it is not about letting someone die at all.

But also, if we go back to labor and money are interchangeable, arguing that myself or anyone else is “just letting someone die” assumes that we owe them their life. Which again means that the government would get to decide when a doctor may retire or otherwise not work.

Waiting in Emergency department

While it’s easy for those of us who aren’t medical doctors to sit at home, and say “someone should help those people” (referring to those who can’t afford to pay for health care), the fact is that any government requirement for them to be helped requires violating the actual enumerated constitutional rights and largely accepted human rights of a number of people, in order to preserve a non-enumerated right of one person.

If you want to help people, you should volunteer to help. Go to school to learn medicine, and do the good deeds you want done. But the moment it becomes compulsory for you or anyone else, it is no longer moral.

With the number of charities that were doing great work to help the less fortunate before laws like this were passed, the idea that such people didn’t get help, is misguided. While there were some people who did not receive care, there were a good number who did. But more importantly to libertarians like me, liberty remained in tact, and not one right was violated.

Recently on Stossel, Ann Coulter made an argument that was factually accurate, yet fundamentally wrong if she wishes to fight for liberty, where she is in essence proposing to treat the symptom, not the cause.

She argued that drugs should be illegal because of our welfare state. Meaning that because a drug user destroys themself, they usually end up in a hospital with conditions arising from drug use. Rarely can they afford to pay for treatment since many are unemployed and/or broke from their habit; so as a result, their expenses are often at the expense of others. Therefore; by her logic, these drug users are violating our right to property (money) by burdening us with the costs born from their habit.

Ann Coulter

The reason this argument upsets me is that she’s going after the users who are only hurting themselves instead of going after the government for compelling hospitals to help them.

But hospitals, like any other business, should have the right to choose whether to help someone based on their own criteria. Make it easier for a hospital to garnish accounts, property, and wages if the patient agrees to it, or allow them to let nature take its course if the patients refuse.

If a hospital wants to have a free clinic supported by charitable donations, they should be lauded for doing so. Many already do this. But if you opt to kill yourself, or engage in behavior that may get you killed, that’s your right. It’s none of the government’s business, and certainly not the responsibility of hospitals and taxpayers to take that right from you.

When I make this argument, people accuse me of sociopath wanting others to die. But like any other strawman argument and ad hominem attack, that’s not what I said—it’s a diversionary argument. I don’t want people to die, and would vehemently fight to save a family member from their attempts at hari-kari, but I’m not OK with being pilfered of my earnings to keep the entirety of the American populace alive, especially those in danger due to their own lack of personal responsibility or desire to die.

As I said in my previous article, illogical arguments that destroy your rights, in a free country, the starting point must be that everything is legal. From there, one must make a case as to why something should be made illegal by showing that it infringes on the rights of another. So making laws that protect someone from their own self-destructive behavior is fundamentally wrong.

As long as the government compels hospitals to provide care to people, regardless of whether or not they can pay, then arguing that such activity should remain illegal under that paradigm is fair. The problem with this tactic is that I can make the same argument for taking away alcohol, cigarettes, Cheetos, red meat, or Bloomy’s big soda ban.

So while Ann’s argument makes sense, it only makes sense if we just roll over and take the assault on liberty that is EMTALA. I’ve never gotten the impression Ann Coulter is afraid to say what she thinks, so ignoring this lends me to believe that she’s either given up fighting for liberty in favor of taking the path of least resistance, she’s ignorant, or there’s something else at play; which I’ll get to in a moment.

Another common argument is that it is illegal because it cannot be easily taxed. If I apply some basic skepticism, I have to look at this is a false argument too. First, while I think politicians are not always honest, I don’t believe they’re evil. I can’t rationally imagine they sit in a room and say, “We can’t let people do something they love unless we figure out a way to tax it.” I think one has to be mighty jaded and cynical to believe that’s happening. I can’t prove it doesn’t, but I’m not buying it until someone shows me evidence it does. Politicians are people, just like you and I; let’s not make them out to be satan’s minions.

Just a dude growin’ some bud

Although marijuana is significantly easier to grow than tobacco in the U.S., the fact remains it can be done, and prior to corporations with assembly lines, it was done. Yet, companies assemble cigarettes and people buy them because it’s easier than doing it themselves. The government overtaxes them like it’s part of their religion, which I believe it actually may be, but people don’t seem to care enough to resort to making their own. I have a friend who buys raw tobacco and makes them because he’s poor and it’s cheap, so it is done on occasion, but most simply can’t be bothered.

So where do I believe the problem truly resides? Ignorance and religious conditioning. The ignorance part is seen every time someone makes the improper statistical argument that marijuana is a gateway drug (Also explained in illogical arguments that destroy your rights). People believe marijuana is capable of doing a myriad of things that science has proven it can’t or generally won’t do.

As for the religious component; we’ve been conditioned to believe using mind-altering substances is a morally wrong thing to do, regardless of the fact it isn’t harming anyone else. Even alcohol, which is legal now by virtue of the disaster of prohibition, is still restricted on Sundays and after certain hours of the evening in most states; this is solely because of religious values. Don’t believe me? Remind me again, what is special about Sunday?

While I don’t necessarily believe politicians are consciously outlawing such things based on religious views, I believe that religious conditioning is causing them to subconsciously make decisions they feel are morally just, based on what they’ve been taught, not what science might have proven to the contrary. Much like a bad detective may look for evidence that a husband is his wife’s murderer based on statistics and pre-conceived notions instead of following the evidence without bias.

The 1st Amendment

While we have a clear first amendment that prohibits laws establishing or prohibiting religion, we seem to be far too tolerant with laws that are based on religious principles instead of the protection of one’s rights.

Since this is a fine line, lawmakers make diversionary arguments to deflect away from the fact their legislation violates the spirit of the 1st amendment such as one like Ann Coulter’s argument. It’s easier to attack the drug user’s rights than to fight Washington. Since they’ve been conditioned by their religion to believe that these people are behaving immorally, taking that right away from them is inherently good in their eyes.

Because Americans are a caring and moral people, we’re quick to pass laws to prevent them from killing themselves or being declined a life-saving service they cannot pay for—liberty for the doctor or taxpayer be damned. But when us libertarians argue to let people use, we also have to be OK with letting those people die. If you cannot reconcile that, then you must side with Ann Coulter on this issue.

Note about the author: I have never used, nor have much interest in using marijuana. I care about liberty, not getting high.

One of the things that I find most troubling with the public’s attitude towards government is the misunderstanding of what the government is, what it is for, and how it was designed to be used.

We elect representatives to protect our rights, as enumerated in the Constitution, but that are deemed innate among each of us, simply be virtue of being alive. If we strictly adhered to the Constitution, that’s pretty much all government would do.

With that in mind, I’d like to remind people what our forefathers intended for government: it is essentially an extension of you. We pay our government officials to do things that we can’t be bothered to do ourselves because we don’t have the individual resources, money, time, or expertise. Everything the government does, is literally done at your behest.

Below are a few glaring examples of where government has overstepped its Constitutionally-defined bounds. But using these examples, I’m sure you can think of many more; which is why I have a “comments” section below this post. Please, spout off at your leisure.

For those of you, like me, that do not use recreational drugs such as marijuana, I have a bit of information that may surprise you: I solemnly swear to you that you have several acquaintances that smoke marijuana. If you’re a realist, you already know this. But if you’re a prude, you’re saying, “I would never be friends with someone like that.” I promise if you are the latter, you are indeed friends with someone like that—they just know you’re a prude and bite their tongue to avoid your reaction.

So imagine that this person happens to be your favorite neighbor, which it probably is, because trust me when I tell you that marijuana users can be quite entertaining. Now imagine if you knew they were smoking it next door. Would you go over, barge in, put a gun to their head, and demand they stop immediately or you’ll use deadly force?

I’m guessing your answer is no.

Conversely, if you knew your favorite neighbor were over there molesting a child or murdering their spouse, unless you’re the most depraved of individuals among us, you would not hesitate to intervene and potentially stop them with deadly force.

So the difference is obvious. One is a personal choice without a victim. One is a blatant infringement on someone’s right to life and liberty.

So if you insist on making something illegal, at least hold yourself to a standard that says you would intervene yourself if there were no such thing as government to do it for you. Because in both the above scenarios, if you call 911, people with guns will shop and potentially use lethal force on your behalf.

The other issue is a little more subtle, yet equally troubling; tolerating things you wouldn’t dream of tolerating if it were done to you personally.

Imagine you had a nice house with an unused extra bedroom. A friend of yours is down on their luck, lost their job, and can’t afford the apartment they’re currently in. So you offer to let them stay at your place rent free because you’re a good person, and you believe that it will be a short-term cohabitation.

The days turn into weeks, then months. You even tell your friend about some job leads you’ve heard of that you know he could do, but your friend’s answer is always the same.

While I’m living here off of you and not paying anything, I’m going to ride it out for my ideal job. I could take a lesser job for now in order to earn something while looking for a better job during my off time, but I’d rather not.

Is there anyone among you that wouldn’t grab that freeloader by the scruff of their neck, bury your foot in their salad shooter, and tell them never to come back? I’d be furious! Yet we all allow this to happen every single day with unemployment insurance. That’s your money they’re living off of! Many could work and take a less optimal job, but they choose not to while there’s “free money” just lying around.

If you read my previous post about privatizing everything, and you think I’m onto something, then maybe it’s time to do some serious blue sky thinking and look at getting rid of government subsidized unemployment insurance in favor of a private version.

You may point out that no one offers private unemployment insurance. Ss far as I know, you’re likely be right. But that’s only because the government has a monopoly on it; and therefore private insurers aren’t bothering to even try. You’re being pilfered for the government’s unemployment insurance, so why would anyone pay additionally for a private option on top of that since opting out of Uncle Sam’s isn’t allowed?

I propose that we demand the government give people their money back and let them use that money to buy private insurance if they want, or live with the consequences of that risk if they choose not to. Liberty doesn’t just mean you have the right to have fun and enjoy life, it also means you have the right to gamble and fail. I will never acknowledge someone was successful if there was no risk of failure to begin with.

One thing I know about the private sector is this. If there’s a market for something, there’s an entrepreneur willing to provide it for a fee. If you get rid of the government monopoly on such things, private insurers would surely offer unemployment insurance for a nominal fee. Likely for less than the government does, and with far less waste and abuse.

So remember, if you wouldn’t do it yourself if you could, don’t ask government to do it for you.

I had a debate with a friend of mine about the insurance mandate. He professes to be a limited government guy that supported Reagan, yet he recently voted Democrat twice, is a proud union employee of the state, and supports socialized medicine. You know—a traitor. (I am kidding; he is a friend, just a misguided one from where I sit.) Needless to say, he and I don’t agree on much these days politically.

My work history includes years in the insurance business, so I have to say that the argument for the health insurance mandate makes mathematical sense—sort of. We pay at an early age into insurance we will rarely use while we’re young and healthy, so that later in life when we start to need it more, that money is there waiting for us. Think of it as health savings and insurance.

By doing so, we increase the insurance company’s revenue now—and thus reduce their losses which results in lower rates for everyone later. In an odd sort of way, it’s the same as the argument that lowering taxes increases revenue because the economy grows; it’s just that the cause and effect are swapped.

But the argument is only logical because it is based on an assumption I cannot agree with—the assumption that everyone has a right to health care. If we as a country feel that people have a basic right to health care, then the insurance mandate is necessary and mathematically sound.

I however, am quite annoyed with the idea that health care is a substance like air and water, that we should all have access to. I instead know that health care is a service provided by people who spent a lot of time and money in order to earn a living. And, you don’t have a right to that service if you cannot pay for it.

The United States Constitution

Our Constitution gives you the right to life, not the right to health care. A right to the life that genetics, nature, and dumb luck provides you.

Health care is a service that can extend that life, provided by professionals that offer that service, in order to earn a living. If you want a better and longer life, you have to pay them for it. Otherwise, when your time comes, that’s your time to go. It may seem heartless, but the circle of life is that all living things feed off of other living things and then eventually die themselves. Nothing gets out alive.

Let’s imagine a scenario where lives aren’t on the line for a minute. Your car breaks down, and you really need your car to get to work. So you take it to the mechanic. They advise you that you need a $500 repair, but you don’t have that kind of cash. Do you get to demand they help you and you’ll pay them later if you can?

Well, doctors are ultimately mechanics for humans. If they are willing to help for free, for a lesser fee than they’d charge medicare (Which is currently prohibited by law, believe it or not), or for a promise to pay in the future, then that’s great. Otherwise, the person needing care needs to find another doctor or accept the consequences of the life they chose and/or the bad fortune that befell them.

We have been taught that caring for others is just the right thing to do, and I agree, entirely. But, I don’t believe that doctors are heartless people who would never help anyone, and history shows this to be true. While some patient-dumping was common practice, it certainly wasn’t a unilateral action. Remember that many of them joined that profession because they love helping people.

But all free people should have the right to choose who we wish to help, who we can afford to help, and who doesn’t deserve our help. And the chronic meth head, alcoholic, and serial moocher are not on my list of acceptable benefactors.

Socialized medicine proponents often paint the picture that everyone who needs health care and can’t afford it are victims of society. But this is a false argument. Often, society is a victim of them, since we’re forced to pay for their care through higher prices, benefit fraud, and tax subsidies.

I think we all know people who can’t keep a good job because they drink too much, abuse their body, voluntarily miss work, don’t apply to begin with, and aren’t motivated to be successful—the type of people who work the hardest at how to afford work.

So then the abuse on their body catches up with them, and because they don’t have a job, they don’t have insurance. Now they need care because of their life choices, and they can’t afford that help. They are responsible for the life they’ve led, and they either need to find a way out of their troubles, or they will die as a martyred good example for others to not to be like them. Yet, under our current system, the rest of us become financially liable for them.

I’ve had a few people like this in my life because I don’t always hang out in the ritziest circles. I like some of these people dearly, but I also know that they are their own worst enemy, and the idea that society should take care of them is nonsense.

There is a phenomenon called the Peltzman Effect which says that the more safety you provide someone, the more risky behavior they will engage in. If you’ve seen someone driving like an idiot in the snow because they have a 4wd, you’ve seen the Peltzman Effect in action. If we want everyone to be self sufficient, we need to stop allowing people to so easily be dependent on others.

I believe that the only way to truly reduce health care expenses is to take away that safety net of guaranteed health care, take away government regulations that hinder competition, give doctors rights to work for a reduced rate if they choose to help the poor, introduce loser pays legislation and other legal reforms, and generally get the government out of the way of the health and insurance industry, letting the free market do what it does best; drive down costs.

In the Affordable Care Act, AKA Obamacare, there is a provision that requires health insurance companies cover pre-existing conditions. While the majority has condemned the insurance mandate of the ACA, most are in favor of pre-existing condition coverage being forced onto health insurers.

However, I feel that this is unwitting hypocrisy. How can someone oppose the government forcing them to pay for something but be OK with the government forcing someone else to? We oppose the mandate because we empathize with those who feel they don’t need to buy health insurance right now. But with pre-existing conditions, we then imagine situations where we lose our job and insurance and then are unable to get coverage because of pre-existing conditions, and lose our wonderful powers of empathy we had a moment ago and decide “f*** the insurance companies.”

This is what happens when people don’t care where money is coming from or who the loss hurts, as long as it benefits them personally.

It seems cruel to people that insurance companies would deny pre-existing conditions, but quite frankly, it’s wrong for us to expect them to cover them. I’d like to think it is because people don’t fully understand the issues with this, so having an insurance background, I’ll try to explain.

Imagine you decide to trade in your car which happens to have a irreparably damaged engine—now only serving the function of an industrial-sized paperweight. The car should be worth $5,000, but it needs $3,000 worth of repairs. The dealer takes the car in on trade for $2,000, and then resells it without fixing the engine. Instead, they sell the new buyer a $1,000 warranty. The new owner takes the car to a repair shop to address the blown engine, submits the claim, and now the $1,000 policy is supposed to pay for a $3,000 engine repair everyone knew it needed before all of this started?

Engine Which Has Suffered a Connecting Rod Failure

The insurance company would immediately take a $2,000 loss that it would have no way to recover since the policy was paid in full up front for $1,000. While the consumer and dealer might think this is awesome, the insurance company and all its employees who are about to go out of business because they’re repeatedly taking unrecoverable loss, won’t be as pleased.

The ultimate truth is that covering a pre-existing condition is not insurance, it’s a grant.

Insurance is designed so that the insured pays a premium up front, and in return, the insurer takes a financial risk that the insured can’t afford to take themselves. What’s the risk you ask?

Imagine you open a collision policy, and then pay your first premium of $200. On the way home from the agent’s office, you plow into someone and send them to the hospital with a quarter-million dollar medical bill. Guess what? The insurance company just lost $249,800 on you, and there is nothing to stop you from canceling your policy immediately after, leaving them with a massive loss. That’s a legitimate risk they take every single day.

The way they make a profit is by employing actuaries who calculate the insurance company’s anticipated claims using mathematical models, then the insurer charges a percentage above that in hopes the actuaries are have nailed their projected losses. You the consumer benefit because you passed that risk of a $250,000 settlement you might have incurred and can’t afford onto the insurance company, in favor of a monthly payment you can afford.

Here’s the reason I say that covering pre-existing conditions is a grant. What is to stop you from dropping your insurance company after you’ve had a massive claim like that? The answer is nothing. In the accident situation I explained, it is the risk the insurance companies take. While they lost, risk is the business they are in after all.

But in the pre-existing condition situation, there is absolutely no risk. You already have the condition, and they are going to be expected to pay for it. The word risk implies they may or may not incur damages, but with pre-existing conditions, risk is replaced with certainty because now they are liable for something you knew existed—because it was PRE-EXISTING.

Imagine you owned an insurance company and someone drove up with their car on a tow truck smashed to bits, requesting to start a full coverage policy with you. Are you really going to agree to that deal knowing that the claimant is going to give you $200 only to file a $10,000 claim tomorrow? If you’re answer is yes, you may want to avoid starting your own company. So, using the “Golden Rule” as a standard, why are we doing unto them, what we wouldn’t want done unto us?

I am not a heartless person who thinks people should be left to die. But, aside from the obvious personal responsibility issues of people who can buy insurance but opt not to, I believe we should not be treating insurance companies as if they’re Satan in business form, and that taking advantage of them should be considered an acceptable or even honorable practice. They employ a lot of people and help keep our economy strong by assuming those risks most of us can’t afford for a nominal fee we can. If you don’t like it, feel free to take that risk yourself if you can afford to.

Contrary to left-wing beliefs, insurance companies do not have a bottomless wallet. They can, and often do, go out of business if their losses become excessive, just like any other business. Which hurts all the people who work for them.

So while this law doesn’t pass the costs onto the taxpayer per se, insurance companies will pass it to the consumer in the form of raised rates, lest they go out of business. Many of you have no doubt noticed the rate increases already. And while we’re at it, taxpayer and consumer are generally the same people; it’s just the former implies the government pilfered a few bucks first.

There is a better way to improve the health care system through deregulation and tort reform which would lower costs. Taking advantage of legitimate businesses that are then forced to pass those damages onto us is not the answer.

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log·i·cal: capable of reasoning or of using reason in an orderly cogent fashion lib·er·tar·i·an: an advocate of the doctrine of free will; a person who upholds the principles of individual liberty especially of thought and action